State Public Option Act: Expanding Medicaid Buy-In and Primary Care Access
This bill aims to establish a State public option through Medicaid, allowing residents without existing coverage to purchase a high-quality, low-cost health insurance plan starting January 1, 2025. Citizens gain a new, potentially more affordable insurance alternative, with eligibility for premium tax credits and cost-sharing reductions to lower out-of-pocket expenses. The act also renews higher Medicare-level payment rates for primary care providers under Medicaid and mandates coverage for comprehensive sexual and reproductive health services.
Key points
New Insurance Option: States can allow residents to buy into Medicaid coverage (Medicaid Buy-in) if they are not concurrently enrolled in another health plan, effective January 1, 2025.
Affordability and Subsidies: Individuals in the Buy-in program will pay premiums and cost-sharing, but they will be eligible for Premium Tax Credits and Cost-Sharing Reductions, similar to plans offered on the Health Insurance Exchange.
Provider Payments: The act renews and expands higher payment rates (at least 100% of Medicare rates) for primary care services furnished by physicians and certain advanced practice clinicians under Medicaid.
Mandatory Coverage: State Medicaid plans must include comprehensive sexual and reproductive health care services, including abortion and abortion-related services, starting January 1, 2025.
Expired
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